Oregon Medicaid Reimbursement

Many state Medicaid programs provide at least some reimbursement for telemedicine services. To date 35 states have rules relating the reimbursement of telemedicine services. A significant number of them have the same provisions as those offered by Medicare. For the most part states have used the Medicare guidelines to provide reimbursement; however, others have sought waivers in order to provide such things as remote diagnostics or remote monitoring for patients with chronic diseases. The biggest incentive for states to reimburse for telemedicine services was the promise of reduced health care-related transportation costs. As a result many state Medicaid programs worked with telemedicine programs to establish telemedicine reimbursement policies. Unfortunately the full potential of that promise has not been realized due in part to low utilization rates and/or poor tracking of the telemedicine delivered services resulting in a limited amount of solid cost and benefit data. Further significant expansions of state Medicaid reimbursement policies are going to be seriously impacted by the serious economic constraints facing most state agencies, and solid data will need to be provided before any new or expanded coverage will be considered.

Oregon's Medicaid policy for telemedicine reimbursement is very progressive. Original rules were adopted shortly after the passage of HJR 4 by the 2003 Legislative Assembly. The rules now include provision for reimbursement for phone and email when video services are not available.

Despite the progressiveness of the policy, utilization has been very low. In Oregon, 85% of Medicaid providers are under managed care contracts. Only 15% are fee-for-service. While the fee-for-service contractors are required to reimburse for services delivered telemedically, managed care contractors are not required to do so unless the provision has been negotiated into their contracts. One of the policy goals for TAO is to work with the managed care contractors to include in their contracts payment for services delivered telemedically.